Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1070 (doi:10.1542/peds.2008-0179)

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LETTER TO THE EDITOR

Overprescription of Antireflux Medications for Infants With Regurgitation

Francesco Savino, MD, PhD
Emanuele Castagno, MD
Department of Pediatrics,
University of Turin,
Regina Margherita Children's Hospital,
10126 Turin, Italy

To the Editor.—

We read with great interest the article by Khoshoo et al,¹ and we largely agree with it; however, we would like to express some opinions on antireflux therapy.

Regurgitation is a physiologic and transient event during the first months of life and must be clearly distinguished from gastroesophageal reflux disease (GERD), because only the latter should be treated.^2,3 It is everyday experience that most infants with persistent regurgitation do not need drug therapy to improve their symptoms; however, antireflux medications are commonly prescribed to children without GERD and before any diagnostic tests are performed. We are impressed by the high reported percentage of subjects who have received metoclopramide and proton-pump inhibitors. Despite its widespread use in some countries, the efficacy of metoclopramide in infants with regurgitation and GERD is not supported by current evidence, and frequently reported adverse effects arouse concern about its misuse, particularly in young infants.⁴ Also, proton-pump inhibitors seem to be too easily prescribed for infants without documented esophagitis.

We agree with Khoshoo et al about the primary importance of parental education and reassurance, along with lifestyle changes (eg, appropriate positioning), for the management of regurgitation. Also, dietary treatment could be considered a first-line approach, and these infants should undergo appropriate follow-up; the misuse of hypoallergenic and thickened formulas could lead to nutritional impairment.⁵ Another step should be the administration of antacids along with dietary and postural intervention. In case of failure, antireflux medications should be prescribed after appropriate diagnostic tests have been performed.

FOOTNOTES

Statements appearing here are those of the writers and do not represent the official position of the American Academy of Pediatrics or its Committees. Comments on any topic, including the contents of PEDIATRICS, are invited from all members of the profession; those accepted for publication will not be subject to major editorial revision but generally must be no more than 400 words in length. The editors reserve the right to publish replies and may solicit responses from authors and others.

Please see www.pediatrics.org for instructions on submitting letters.

REFERENCES

1. Khoshoo V, Edell D, Thompson A, Rubin M. Are we overprescribing antireflux medications for infants with regurgitation? Pediatrics. 2007;120 (5):946 –949[Abstract/Free Full Text]
2. Aggett PJ, Agostani C, Goulet O, et al. Antireflux and antiregurgitation milk products for infants and young children: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2002;34 (5):496 –498[CrossRef][Web of Science][Medline]
3. Rudolph CD, Mazur LJ, Liptak GS, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001;32 (suppl 2):S1 –S31[CrossRef][Web of Science]
4. Hibbs AM, Lorch SA. Metoclopramide for the treatment of gastroesophageal reflux disease in infants: a systematic review. Pediatrics. 2006;118 (2):746 –752[Abstract/Free Full Text]
5. Savino F, Castagno E. Is cornstarch-thickened milk formula better than strengthened regular milk formula for infant regurgitation? Nat Clin Pract Gastroenterol Hepatol. 2008;5 (2):72 –73[Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Savino, F. Articles by Castagno, E. Search for Related Content PubMed PubMed Citation Articles by Savino, F. Articles by Castagno, E. Related Collections Gastrointestinal Tract Social Bookmarking                         What's this?